Provider Demographics
NPI:1003954918
Name:CROSS, LEILA KAY (BA)
Entity Type:Individual
Prefix:
First Name:LEILA
Middle Name:KAY
Last Name:CROSS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 E FOREST PARK DR
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2259
Mailing Address - Country:US
Mailing Address - Phone:724-496-3365
Mailing Address - Fax:
Practice Address - Street 1:800 VOLUNTEER DR
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-5472
Practice Address - Country:US
Practice Address - Phone:615-446-7650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TN2125224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health